中心动脉压与血管功能,1、中心动脉压机制与方法评价 2、中心动脉压的意义 3、血管功能指标和意义 4、血管功能指标临床研究,内 容,1、中心动脉压机制与方法评价 2、中心动脉压的意义 3、血管功能指标和意义 4、血管功能指标临床研究,内 容,动脉压相关因素,心搏量 末梢阻力 血管壁硬度 反射波,中心动脉压,主动脉顺应性（大血管硬度） 反射波 时间 幅度,London and Guerin. Am Heart J 1999;138:220-224,Normal,Decreased aortic compliance,Systole,Diastole,40%,60%,60%,50%,50%,50%,Aortic compliance and pulse pressure,Systole,Diastole,Windkessel function,大动脉顺应性降低，弹性降低，收缩压力在动脉内不能得到缓冲，使收缩压升高。 舒张期大血管弹性回缩减低，使舒张压降低。 结果：脉压增大,主动脉顺应性下降,Augmentation and reflection wave,Incident wave,Reflection wave,McDonalds fourth edition,Systolic BP,Augmentation Index,Diastolic BP,Arrival of reflection wave,Arterial pressure waveform and reflection wave,反射波机制对中心动脉压的影响,脉搏波传导速度(PWV) -反射波速度 阻力微、小动脉反射位点 动脉弹性-反射波幅度 心率-反射波在收缩期叠加的幅度,AI与主动脉压、脉压的测量,1、中心动脉压机制与方法评价 2、中心动脉压的意义 3、血管功能指标和意义 4、血管功能指标临床研究,内 容,Attenuation of peripheral augmentation effect by arterial stiffness Peripheral BP and central BP,Nichols WW et al. 1993,68 years old,24 years old,50,100,150,(mmHg),50,100,150,(mmHg),0,20,40,60,80,100,120,140,160,-49,50-59,60-69,70-,31,49,32,31,(mmHg),Reflection component,Age,Estimated aortic blood pressure,Kohara K et al. J Am Geriatr Soc, 1999,Incident component,Aortic diastolic BP,Age and central blood pressure,Radial BP was matched as 150 mmHg in all age groups,Systolic hypertension Wide pulse pressure,Central hypertension,augmentation by reflection pressure wave,Arterial stiffness,Reduced compliance Impaired Windkessel function,The Great Hemodynamic Divide,Mean Pressure,Anatomy Heart, small arteries Aorta,Physiology Cardiac output Stiffiness Peripheral resistance,BP SBP , DBP SBP DBP Event Risk Risk,Pulse Pressure,The Strong Heart Study,Central Blood Pressure Better predicts Cardiovascular Events than Does Peripheral Blood Pressure 2662 patients, 63yrs, follow-up 3.4y,Roman MJ, et al. AHA Sept. 2005,The Strong Heart Study: Cox regression analyses (校正年龄、性别、体重指数、吸烟、LDL-C、DM),主动脉SBP和PP与CVD发生率独立相关，RR/10mmHg分别为1.07与1.10, p分别为0.043与0.009。 进一步校正颈动脉粥样硬化病变，主动脉PP仍然与CVD显著独立相关。,Reflection of pressure wave as risk factor ESRD patients,Blacher et al. Circulation, 1999,1.0,0.75,0.50,0.25,0,0,35,70,105,140,Survival rate for cardiovascular death,Time (month),PWV9.4m/s,9.4PWV12.0m/s,12.0m/s PWV,1.0,0.75,0.50,0.25,0,0,35,70,105,140,Even free rate for cardiovascular accidents,Time (month),Augmentation index 1 群,Augmentation index 2 群,Augmentation index 3 群,Augmentation index 4 群,London GM et al. Hypertension, 2001,中心动脉压和脉压升高对 心血管系统影响,左室后负荷增加，左室重构 冠状动脉灌注下降，储备功能下降， 心肌缺血 内皮损伤和功能紊乱，动脉硬化性疾病 进展,Circulation 2004;109:184-189,NO lesions,12 11 10 9 8 7 6 5 4 3,Augmented pressure mmHg,One vessel,Two vessels,Three vessels,AI and coronary heart disease Association between aortic AI and coronary arteriogram,160,140,120,100,80,60,Smulyan H et al. Ann Intern Med 2000,160,120,80,160,120,160,120,80,Adolescence,Middle age,Elderly,500,500,500,0,0,0,0,150,0,150,0,150,Ascending Aortic BP (mmHg),Ascending Aortic blood flow (ml/s),Coronary blood flow (ml/min),80,McDonalds fourth edition,Blood pressure (mmHg),吸烟对中心动脉压和周围动脉压的影响,50,60,70,80,90,100,110,120,130,140,-8,-7,-6,-5,-4,-3,-2,-1,0,1,2,Aortic AI (%),*,Brachial BP,Aortic BP,*,* p0.05,Non-smoker (n=116) Smokers (n=41),Hypertension. 2003;41:183-187,J Am Coll Cardiol 2002;39:1005,160 150 140 130 120 110 100 90 80 70,Control subjects (n=68),Hyperlipidemia (n=68),0.01,*,Blood pressure (mmHg),Peripheral BP Central BP,Hyperlipidemia and central BP,Hypertension 43:176181, 2004,Glucose intolerance and arterial stiffness The Hoorn Study,1.2 1.0 0.8 0.6,243,129,256,60 55 50 45 40,120,74,125,34 33 32 31 30,261,170,188,Total arterial compliance (SV/carotid PP, ml/mmHg),Transmission time from carotid artery to femoral artery (msec),Augmentation index (%),*,*,*,*,Control Impaired glucose tolerance Type 2 DM,Change in HR (bpm),-10,-8,-6,-4,-2,0,Change in AI (%),-1.2,-1,-0.8,-0.6,-0.4,-0.2,0,Change in PWV (m/sec),-5,-4,-3,-2,-1,0,1,2,3,4,Asmar RG, et al. Hypertension. 2001;38:922,*,*,MeanSD. *p0.05, * p0.001 vs atenolol.,Effect of antihypertensive drugs on brachial BP and central BP,Diastolic BP on brachial artery was matched for 1 year,Perindopril / indapamide (n=204),atenolol (n=202),Am J Hypertens 17:118123, 2004,70,80,90,100,110,120,130,140,150,160,170,Placebo,*,*,*,*,*,*,*,*,*,*,*,*,Blood pressure (mmHg),peripheral central,32 elderly hypertensive patients (age 65-80) were treated for 4 weeks each drugs in double blind and cross-over fashion.,Effect of antihypertensive drugs double blind and cross-over study,ACE inhibitor,